Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery
Authors: Yuhang Zhu, Fangfang Wang, Jue Zhou, Shuiqin Gu, Lianqing Gong, Yaoyao Lin, Xiaoli Hu, Wei Wang, Aihua Zhang, Dongmei Ma, Chunxiao Hu, Yan Wu, Lanzhong Guo, Limin Chen, Leiyin Cen, Yan He, Yuqing Cai, Enli Wang, Honglou Chen, Jing Jin, Jinhe Huang, Meiyuan Jin, Xiujuan Sun, Xiaojiao Ye, Linping Jiang, Ying Zhang, Jian Zhang, Junfei Lin, Chunping Zhang, Guofang Shen, Wei Jiang, Liuyan Zhong, Yuefang Zhou, Ruoya Wu, Shiqing Lu, Linlin Feng, Hong Guo, Shanhu Lin, Qiaosu Chen, Jinfang Kong, Xuan Yang, Mengling Tang, Chang Liu, Fang Wang, Xiao-Yang Mio Hu, Hye Won Lee, Xinfen Xu, Rong Zhang, Nicola Robinson, Myeong Soo Lee, Jisheng Han, Fan Qu
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. <h3>Objective</h3> To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. <h3>Design, Setting, and Participants</h3> This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. <h3>Interventions</h3> Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. <h3>Main Outcomes and Measures</h3> The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). <h3>Results</h3> Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98;<i>P</i> = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2];<i>P</i> &lt; .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2];<i>P</i> &lt; .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1];<i>P</i> &lt; .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1];<i>P</i> = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98;<i>P</i> = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. <h3>Conclusions and Relevance</h3> Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. <h3>Trial Registration</h3> Chinese Clinical Trial Registry Identifier:ChiCTR2000038417